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O objetivo deste estudo foi avaliar o grau de implantação e de impacto do protocolo de vigilância do óbito por tuberculose (TB) em um município de grande porte e com elevada carga de TB. Para esta pesquisa avaliativa, elaborou-se um modelo lógico e matriz de julgamento. Os dados primários foram coletados a partir de um questionário aplicado aos profissionais e os dados secundários foram obtidos na Secretaria Municipal de Saúde de Manaus, Amazonas, Brasil. O impacto da adoção do protocolo foi analisado pelos indicadores de resultados e a evolução das taxas de incidência e mortalidade por TB, a partir da regressão linear simples e variação percentual. O grau de implantação da vigilância do óbito com menção de TB identificado foi parcial (51%). Quanto à evolução dos indicadores de incidência e mortalidade por TB, observou-se tendência significativa de aumento da taxa da incidência de TB no período de 2006 a 2019. A mortalidade por TB e a proporção dos óbitos com confirmação laboratorial para TB apresentaram incremento após a implantação do protocolo, indicando aumento da vigilância. A implantação parcial da vigilância do óbito de TB indica necessidades de mudanças no processo de trabalho da equipe que gerencia o Sistema de Informações sobre Mortalidade e o Programa de Controle da TB municipal. As mudanças observadas demonstram mais qualificação das informações do óbito por TB, assim como a vigilância no diagnóstico da TB contribuiu para a definição de casos com confirmação laboratorial para TB.

The study aimed to assess the degree of implementation and impact of the protocol for surveillance of deaths from tuberculosis (TB) in a large city with a high TB burden. For this evaluative study, a log frame model with a assessment matrix was elaborated. Primary data were collected with a questionnaire applied to healthcare workers, and secondary data were obtained from the Manaus Municipal Health Department, Amazonas State, Brazil. The impact of the protocol’s adoption was analyzed according to the indicators of results and evolution of TB incidence and mortality rates based on simple linear regression and percent change. The degree of implementation of surveillance of deaths with mention of TB was partial (51%). Evolution of TB incidence and mortality showed a significant upward trend in TB incidence from 2006 to 2019. TB mortality and the proportion of deaths with laboratory confirmation of TB showed an increase in the protocol’s implementation, indicating an increase in surveillance. Partial implementation of TB mortality surveillance suggests the need for changes in the work processes of the team managing the Brazilian Mortality Information System and the Municipal TB Control Program. The changes demonstrate improvement of information on TB deaths and the contribution of surveillance of TB diagnosis to definition of cases with TB laboratory confirmation.

El objetivo de este estudio fue evaluar el grado de implantación y de impacto del Protocolo de vigilancia de óbitos por tuberculosis (TB) en un municipio de gran tamaño y con elevada carga de TB. Para esta investigación evaluativa se elaboró un modelo lógico, así como una matriz de juicio. Los datos primarios se recogieron a partir de un cuestionario aplicado a profesionales y los datos secundarios se obtuvieron de la Secretaría Municipal de Salud de Manaos, Amazonas, Brasil. El impacto de la adopción del protocolo se analizó mediante indicadores de resultados, así como la evolución de las tasas de incidencia y mortalidad por TB, a partir de una regresión lineal simple y variación porcentual. El grado de implantación de la vigilancia del óbito con mención de TB identificado fue parcial (51%). En cuanto a la evolución de los indicadores de incidencia y mortalidad por TB, se observó una tendencia significativa de aumento de la tasa de la incidencia de TB en el período de 2006 a 2019. La mortalidad por TB, así como la proporción de los óbitos con confirmación de laboratorio para TB presentaron un incremento tras la implantación del protocolo, indicando un aumento de la vigilancia. La implantación parcial de la vigilancia de óbitos por TB indica que son necesarios cambios en el proceso de trabajo del equipo que gestiona el Sistema de Informaciones sobre Mortalidad y el Programa de Control de la TB municipal. Los cambios observados demuestran más cualificación respecto a la información del óbito por TB, así como la conclusión de que vigilancia en el diagnóstico de la TB contribuyó a la definición de casos con confirmación de TB por parte de laboratorios.

https://doi.org/10.1590/0102-311x00356120

Implantação do protocolo de vigilância do óbito com menção de tuberculose e seus efeitos na vigilância de um município brasileiro de grande porte
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Cordeiro, Dinah Carvalho

; Gonçalves, Maria Jacirema Ferreira

Cadernos de Saúde Pública

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2022, Volume 38 N. 2 elocation e00356120

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0102-311x00356120

Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial
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Kritski, Afranio

; Oliveira, Maria Martha

; Almeida, Isabela Neves de

; Ramalho, Daniela

; Andrade, Monica Kramer de Noronha

; Carvalho, Monica

; Miranda, Pryscila Fernandes Campino

; Dalcolmo, Margareth Pretti

; Braga, Jose Ueleres

; Brígido, Tania

; Mesquita, Eliene

; Dias, Claudia

; Gambirasio, Aglae

; Souza Filho, Joao Baptista

; Detjen, Anne

; Phillips, Patrick Peter John

; Langley, Ivor

; Fujiwara, Paula

; Squire, Stephen Bertel

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0191-2021

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.

https://doi.org/10.1590/0037-8682-0191-2021

Clinical outcomes of patients with pancreatic tumors discussed in Tumor Board
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SILVA, JULIANA RIBEIRO

; RIECHELMANN, RACHEL SIMÕES PIMENTA

; VIZZACCHI, BÁRBARA ALANA

; MOLINA, PATRICIA

; JESUS, VICTOR HUGO FONSECA DE

; COIMBRA, FELIPE JOSE FERNANDEZ

; ALVES, FULVIO APARECIDO SANTOS

; CAMARGO, THAMIRES DE BRITO

; VICENTE, GABRIELA AGUIAR

; SANTOS, DENNYS RIBEIRO DOS

; ANDRADE, VICTOR PIANA DE

; CARVALHO, GENIVAL BARBOSA DE

Revista do Colégio Brasileiro de Cirurgiões

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2022, Volume 49 elocation e20223150

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: as recomendações das decisões em Tumor Board (TB) deveriam ser acompanhadas para identificar barreiras que possam interferir na execução do melhor cuidado para o paciente decidido previamente. O objetivo do estudo é avaliar se a decisão de conduta em TB foi realizada em pacientes com tumores pancreáticos, o status de vida 90 dias após TB e analisar os motivos pelos quais a conduta não foi realizada. Métodos: estudo retrospectivo com pacientes com tumores de pâncreas, avaliados entre 2017 a 2019. Dados epidemiológicos, se a conduta de TB foi realizada, o motivo da não realização, o status de vida em 90 dias após decisão de TB e quantas vezes cada paciente foi discutido em reunião foram coletados. As variáveis categóricas foram comparadas pelo teste de qui-quadrado; variáveis numéricas foram apresentadas como médias e desvio padrão. Resultados: 111 casos, 95 pacientes, 86 (90,5%) com diagnóstico de câncer. Após 90 dias de TB, 83 pacientes (87,37%) permaneceram vivos, 9 pacientes (9,47%) faleceram e 3 (3,16%) perderam o seguimento. A conduta do TB não foi realizada em 12 (10,8%) dos casos e os motivos foram: 25% (3) por perda de seguimento, 8,33% (1) por recusa do paciente e 66,67% (8) devido à piora clínica. Os casos de pacientes com metástases tiveram menor execução de conduta de TB (p=0,006). Conclusões: a conduta do TB é realizada na maior parte dos casos e o motivo mais evidente para o não cumprimento das condutas é a piora clínica do paciente.

ABSTRACT Objective: the recommendations of the decisions made by the Tumor Board (TB) should be followed to identify barriers that may interfere with the execution of the previously decided, best care for the patient. The aim of this study is to assess whether the TB conduct decision was performed in patients with pancreatic tumors, their life status 90 days after the TB decision, and to analyze the reasons why the conduct was not performed. Methods: we conducted a retrospective study with patients with pancreas tumors, evaluated between 2017 and 2019. We collected data on epidemiological status, whether the TB procedure was performed, the reason for not performing it, life status 90 days after the TB decision, and how many times each patient was discussed at a meeting. We compared categorical variables using the chi square test, numerical variables were presented as means and standard deviation. Results: we studied 111 session cases, in 95 patients, 86 (90.5%) diagnosed with cancer. After 90 days of TB, 83 patients (87.37%) remained alive, 9 had (9.47%) died, and 3 (3.16%) were lost to follow-up. The TB decision was not observed in 12 (10.8%) cases and the reasons were: 25% (3) for loss of follow-up, 8.33% (1) for patient refusal, and 66.67% (8) due to clinical worsening. The cases of patients with metastases had a lower rate of TB conduct compliance (p=0.006). Conclusions: the TB conduct was performed in most cases and the most evident reason for non-compliance with the conducts is the patient’s clinical worsening.

https://doi.org/10.1590/0100-6991e-20223150en

Avaliação do desempenho dos serviços de atenção primária à saúde no controle da tuberculose em metrópole do Sudeste do Brasil
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Rabelo, Juliana Veiga Costa

; Navarro, Pedro Daibert de

; Carvalho, Wânia da Silva

; Almeida, Isabela Neves de

; Oliveira, Camila Stefânie Fonseca

; Haddad, João Paulo Amaral

; Miranda, Silvana Spindola de

Cadernos de Saúde Pública

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2021, Volume 37 N. 3 elocation e00112020

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo: A Organização Mundial da Saúde destaca a importância da organização e do desempenho dos serviços de saúde nas ações de controle da tuberculose. O objetivo deste estudo foi avaliar o desempenho dos serviços de atenção primaria à saúde em Belo Horizonte, Minas Gerais, Brasil, em relação às ações de controle da tuberculose nos eixos Estrutura e Processo, antes e após a utilização do instrumento validado denominado Estratificação por Grau de Risco Clínico e de Abandono do Tratamento da Tuberculose (ERTB). Estudo descritivo e prospectivo, no qual foram realizadas duas entrevistas (455 profissionais), tendo a segunda ocorrido após a ERTB. A classificação do desempenho seguiu os valores: ≤ 49,9%, críticos; entre 50% e 79,9%, insatisfatórios; e, ≥ 80%, satisfatórios. Na avaliação comparativa, foi utilizado o teste estatístico de McNemar, com p < 0,05. Após a estratificação de risco, a maior parte das variáveis de cada eixo melhorou significativamente. Nós concluímos que, por meio de um questionário padronizado, foi possível identificar o desempenho satisfatório dos serviços de atenção primária à saúde em Belo Horizonte em relação às ações de controle da tuberculose, na maioria das variáveis avaliadas nos eixos Estrutura e Processo.

Abstract: The World Health Organization highlights the importance of health services organization and performance in tuberculosis (TB) control activities. This study aimed to assess the performance of primary healthcare services in Belo Horizonte, Minas Gerais State, Brazil, in TB control activities in the dimensions Structure and Process, before and after the use of a validated instrument called Stratification by Degree of Clinical Risk and Tuberculosis Treatment Dropout (ERTB). This was a descriptive and prospective study with two interviews (455 professionals), the second of which after the ERTB. Performance classification was: ≤ 49.9%, critical; 50-79.9%, unsatisfactory, and ≥ 80%, satisfactory. The comparative assessment used the McNemar statistical test with p < 0.05. After risk stratification, most of the variables in each dimension improved significantly. The authors conclude that it was possible to identify satisfactory performance in most of the variables assessed in the Structure and Process dimensions in primary healthcare services in Belo Horizonte in relation to TB control activities, using a standardized questionnaire.

Resumen: La Organización Mundial de la Salud destaca la importancia de la organización y del desempeño de los servicios de salud en acciones de control de la tuberculosis. El objetivo de este estudio fue evaluar el desempeño de los servicios de atención primaria en salud en Belo Horizonte, Minas Gerais, Brasil, en relación con las acciones de control de la tuberculosis respecto a los ejes Estructura y Proceso, antes y después de la utilización del instrumento validado, denominado Estratificación por Grado de Riesgo Clínico y de Abandono del Tratamiento de la Tuberculosis (ERTB). Se trata de un estudio descriptivo y prospectivo, donde se realizaron dos entrevistas (455 profesionales), siendo que la segunda se produjo tras la ERTB. La clasificación del desempeño siguió los valores: ≤ 49,9%, críticos; entre 50 y 79,9%, insatisfactorios; y, ≥ 80%, satisfactorios. En la evaluación comparativa, se utilizó el test estadístico de McNemar, con p < 0,05. Tras la estratificación de riesgo, la mayor parte de las variables de cada eje mejoró significativamente. Concluimos que fue posible identificar el desempeño satisfactorio en la mayoría de las variables evaluadas en los ejes Estructura y Proceso de los servicios de atención primaria en salud en Belo Horizonte, en relación con las acciones de control de la tuberculosis mediante un cuestionario estandarizado.

https://doi.org/10.1590/0102-311x00112020 740 downloads

Avaliação do desempenho dos serviços de atenção primária à saúde no controle da tuberculose em metrópole do Sudeste do Brasil
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Rabelo, Juliana Veiga Costa

; Navarro, Pedro Daibert de

; Carvalho, Wânia da Silva

; Almeida, Isabela Neves de

; Oliveira, Camila Stefânie Fonseca

; Haddad, João Paulo Amaral

; Miranda, Silvana Spindola de

Cadernos de Saúde Pública

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2021, Volume 37 N. 3 elocation e00112020

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0102-311x00112020

Effectiveness of screening for tuberculosis in HIV: a pragmatic clinical trial
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Santos, Marcela Lopes

; Batista, Joanna d’Arc Lyra

; Braga, Cynthia

; Silva, Adriana Paula da

; Maruza, Magda

; Souza, Wayner Vieira

; Carvalho, Maria Rosimery de

; Siqueira-Filha, Noemia Teixeira de

; Albuquerque, Maria de Fátima Pessoa Militão de

Revista de Saúde Pública

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2021, Volume 55 elocation 45

Abstract: En | Text: En | PDF: En

ABSTRACT OBJECTIVE: To verify the effectiveness of screening for tuberculosis (TB) on all-cause mortality and tuberculosis cases in newly diagnosed HIV-infected patients through a clinical algorithm based on recommendations of the World Health Organization. METHODS: From March 2014 to April 2016, a pragmatic randomized clinical trial was conducted with newly diagnosed and TB-free HIV-infected adults undergoing antiretroviral therapy for up to one month at a major tertiary hospital for HIV in the state of Pernambuco, Brazil. Participants were randomized into intervention and control groups using an automatically-generated random list, and followed-up for at least 6 months. The intervention group was screened for TB at hospital admission and at every follow-up visit through a series of questions addressing TB-related symptoms (cough, fever, night sweating, and weight loss). Patients presenting with any of these symptoms were referred to a pulmonologist and underwent sputum smear microscopy, sputum culture, and rapid molecular testing (GeneXpert). When at least one test result came back positive, TB treatment was initiated. In turn, if patients tested negative but presented with severe clinal symptoms, TB preventive treatment was initiated. Screening for TB was not performed systematically in the control group. The primary outcome assessed in this study was death from all causes, and secondary outcomes included sensitivity and specificity of this screening test, as well as its detection time. RESULTS: This study evaluated 581 patients, 377 in the intervention group (64.9%) and 204 in the control group (35.1%). In total, 36 patients died during the follow-up period. Of these, 26 (6.9%) were from the intervention group, reaching a cumulative mortality coefficient of 69 per 1,000 inhabitants, and 10 (4.9%) from the control group (p = 0.341), with a cumulative mortality coefficient of 49 per 1,000 inhabitants (p = 0.341).

https://doi.org/10.11606/s1518-8787.2021055002936 84 downloads

Assessment of factors associated with potential drug-drug interactions in patients with tuberculosis and HIV/AIDS
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Resende, Natália Helena de

; Miranda, Silvana Spíndola de

; Ceccato, Maria das Graças Braga

; Reis, Adriano Max Moreira

; Haddad, João Paulo Amaral

; Silva, Dirce Inês da

; Carvalho, Wânia da Silva

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0103-2021

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: The concomitant use of antituberculosis and antiretroviral drugs, as well as drugs to treat other diseases, can cause drug-drug interactions. This study aimed to describe potential drug-drug interactions (pDDI) in patients with TB and HIV/AIDS co-infection, as well as to analyze possible associated factors. METHODS: This study was performed in a reference hospital for infectious and contagious diseases in the southeastern region of Brazil and evaluated adult patients co-infected with tuberculosis and HIV/AIDS. A cross-sectional study was conducted in which sociodemographic, clinical, and pharmacotherapeutic characteristics were assessed. The pDDI were identified using the Drug-Reax software. Association analysis was performed using either a chi-squared test or a Fisher’s exact test. Correlation analysis was performed using the Spearman’s coefficient. RESULTS: The study included 81 patients, of whom 77 (95.1%) were exposed to pDDI. The most frequent interactions were between antituberculosis and antiretroviral drugs, which can cause therapeutic ineffectiveness and major adverse reactions. A positive correlation was established between the number of associated diseases, the number of drugs used, and the number of pDDI. An association was identified between contraindicated and moderate pDDI with excessive polypharmacy and hospitalization. CONCLUSIONS: We found a high frequency of pDDI, especially among those hospitalized and those with excessive polypharmacy. These findings highlight the importance of pharmacists in the pharmacotherapeutic monitoring in these patients.

https://doi.org/10.1590/0037-8682-0103-2021 214 downloads

10.

Effectiveness of screening for tuberculosis in HIV: a pragmatic clinical trial
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Santos, Marcela Lopes

; Batista, Joanna d’Arc Lyra

; Braga, Cynthia

; Silva, Adriana Paula da

; Maruza, Magda

; Souza, Wayner Vieira

; Carvalho, Maria Rosimery de

; Siqueira-Filha, Noemia Teixeira de

; Albuquerque, Maria de Fátima Pessoa Militão de

Revista de Saúde Pública

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2021, Volume 55 elocation 45

Abstract: En | Text: En | PDF: En

https://doi.org/10.11606/s1518-8787.2021055002936

11.

Professional skills for health promotion in caring for tuberculosis patients
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Costa, Amanda de Fátima Alves

; Gomes, Altamira Mendonça Félix

; Fernandes, Ana Fátima Carvalho

; Silva, Lucilane Maria Sales da

; Barbosa, Lorena Pinheiro

; Aquino, Priscila de Souza

Revista Brasileira de Enfermagem

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2020, Volume 73 N. 2 elocation e20180943

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

RESUMO Objetivos: compreender as competências de promoção da saúde encontradas nas falas de profissionais de saúde no atendimento a pacientes com tuberculose. Métodos: estudo qualitativo, desenvolvido com sete profissionais envolvidos no atendimento a pacientes com tuberculose, identificados a partir de abordagem sociocêntrica, cujas falas foram submetidas à análise com base no modelo de competências para promoção da saúde presentes no Consenso de Galway. Resultados: evidenciaram-se quatro domínios: Catalisar mudanças; Liderança; Planejamento; e Parcerias. Esses domínios resultaram das ações de educação em saúde, da contribuição dos profissionais enfermeiros na gestão, busca de atendimento às necessidades dos pacientes e articulação de setores profissionais. Considerações finais: constatou-se a presença de alguns domínios de competências nas falas dos profissionais de saúde, com a citação do enfermeiro no desenvolvimento de competências essenciais para a realização de atividades promotoras de saúde, como a catalisação de mudanças e a liderança no acompanhamento de pacientes com tuberculose.

ABSTRACT Objectives: to understand the health promotion skills found in the speeches of health practitioners in care for TB patients. Methods: qualitative study, developed with seven practitioners involved in care for TB patients, identified from a sociocentric approach, whose speeches were submitted to analysis based on the health promotion skills model in the Galway Consensus. Results: there were four domains: Catalyzing change; Leadership; Planning; and Partnerships. These domains resulted from health education actions, contribution of management nursing practitioners, seeking to meet patients’ needs and articulation of professional sectors. Final considerations: there were some skill domains in the speeches of health practitioners, with the nurse being quoted in the development of essential skills for health promotion activities, such as catalyzing change and leading care for TB patients.

RESUMEN Objetivos: comprender las habilidades de promoción de la salud que se encuentran en las declaraciones de los profesionales de la salud en la atención de pacientes con tuberculosis. Métodos: estudio cualitativo, desarrollado con siete profesionales involucrados en el cuidado de pacientes con tuberculosis, identificados desde un enfoque sociocéntrico, cuyos discursos fueron sometidos a análisis basados en el modelo de competencias de promoción de la salud presente en el Consenso de Galway. Resultados: se evidenciaron cuatro dominios: catalizar cambios; Liderazgo; Planificación; y Asociaciones. Estos dominios resultaron de acciones de educación para la salud, la contribución de enfermeras profesionales en la gestión, buscando satisfacer las necesidades de los pacientes y la articulación de sectores profesionales. Consideraciones finales: se encontró la presencia de algunos dominios de competencias en los discursos de profesionales de la salud, con la cita de la enfermera en el desarrollo de competencias esenciales para realizar actividades de promoción de la salud, como catalizar el cambio y liderar el monitoreo de pacientes con tuberculosis

https://doi.org/10.1590/0034-7167-2018-0943 1981 downloads

12.

Rapid detection of Mycobacterium tuberculosis in children using blood and urine specimens
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Costa-Lima, Juliana Figueirêdo da

; Pimentel, Lílian Maria Lapa Montenegro

; Santos, Fabiana Cristina Fulco

; Salazar, Marcela Pereira

; Duarte, Rafael Silva

; Mello, Fernanda Carvalho de Queiroz

; Schindler, Haiana Charifker

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20200051

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: Laboratory and clinical features of childhood tuberculosis (TB) are non-specific and establishing an accurate diagnosis remains a challenge. This study evaluated a Single tube nested-PCR (STNPCR) to detect genomic DNA of Mycobacterium tuberculosis complex in blood and urine. METHODS: Biological samples were obtained from children (<15 years old) with clinical suspicion of pulmonary and extrapulmonary TB at public hospitals in Recife-Pernambuco, Brazil. Cultures yielded negative results in a majority of childhood TB cases, which are generally paucibacillary. A set of clinical, epidemiological, radiological, and laboratory criteria with evident clinical improvement after anti-TB treatment were frequently used to define childhood TB cases. RESULTS: Ninety children with clinical suspicion were enrolled in this study (44 with TB and 46 without TB). The pulmonary TB group had 20 confirmed cases and 46 negative controls, while the extrapulmonary TB group had 24 confirmed cases. The STNPCR showed sensitivities to pulmonary and extrapulmonary TB of 47.4% and 52.2% (blood) and 38.8% and 20% (urine), respectively. Considering the low performance of STNPCR on separate samples, we decided to perform a combined analysis (parallel sensitivity analysis) of the results from blood and urine samples. The parallel sensitivity increased to 65% in blood and 62.5% in urine. The specificity in both samples ranged from 93.5-97.8%. CONCLUSIONS: Although STNPCR showed moderate sensitivity, the specificity is high; therefore, the test can be used as an auxiliary tool to diagnose TB in children. It is a rapid test that demonstrated better performance than other diagnostic tests in paucibacillary samples as it does in childhood tuberculosis.

https://doi.org/10.1590/0037-8682-0051-2020 474 downloads

13.

Detection of Drug Resistant Mycobacterium Tuberculosis Strains Using Kit SIRE Nitratase®: a Multicenter Study
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Miranda, Silvana Spindola de

; Almeida, Isabela Neves de

; Mansur, Maria de Fátima Filardi Oliveira

; Figueredo, Lida Jouca de Assis

; Carvalho, Wânia da Silva

; Hadaad, João Paulo Amaral

; Diniz, Jaciara de Lourdes do Carmo Guimarães

; Groll, Andrea von

; Silva, Pedro Almeida da

; Lopes, Maria Luiza

; Santos, Marcelo Cordeiro dos

; Brito, Alexandra

; Mello, Fernanda Carvalho de Queiroz

; Malaquias, Thiago da Silva Santos

; Croda, Julio

; Pinhata, Juliana Maira Watanabe

; Oliveira, Rosângela Siqueira de

; Chimara, Erica

; Rossetti, Maria Lúcia

; Halon, Maria Laura

; Lourenço, Maria Cristina

; Medeiros, Reginalda Ferreira de Melo

; Montes, Fátima Cristina Onofre Fandinho

; Machado, Diana

; Viveiros, Miguel

; Kritski, Afrânio Lineu

Brazilian Archives of Biology and Technology

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2020, Volume 63 elocation e20190179

Abstract: En | Text: En | PDF: En

Abstract (1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.

https://doi.org/10.1590/1678-4324-2020190179 905 downloads

14.

Genotype®MTBDRplus and Xpert®MTB/RIF in the diagnosis of tuberculosis and resistant tuberculosis: cost analysis in a tertiary referral hospital
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Soares, Valéria Martins

; Almeida, Isabela Neves de

; Vater, Maria Cláudia

; Alves, Suely

; Figueredo, Lida Jouca de Assis

; Scherer, Luciene

; Kritski, Afrânio Lineu

; Carvalho, Wânia da Silva

; Miranda, Silvana Spindola de

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20190175

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.

https://doi.org/10.1590/0037-8682-0175-2019 1274 downloads

15.

Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system
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Carvalho, Roberta Feijó

; Carvalho, Anna Cristina Calçada

; Velarde, Luis Guillermo Coca

; Rossoni, Andrea Maciel de Oliveira

; Aurilio, Rafaela Baroni

; Sias, Selma Maria de Azevedo

; Schmidt, Christiane Mello

; Moreira, Adriana da Silva Rezende

; Martins, Pedro da Silva

; Gonçalves, Lorrayne Isidoro

; Martire, Terezinha Miceli

; Barbosa, Ana Paula Ferreira

; Santos, Ana Paula Quintanilha dos

; Romanelli, Roberta Maia de Castro

; Oliveira, Maria das Graças Rodrigues de

; Diniz, Lilian Martins Oliveira

; Carvalho, Andrea Lucchesi de

; Lucena, Sheila Cunha

; Cruz, Maria Letícia Santos

; Saavedra, Mariza Curto

; Tahan, Tony Tannous

; Rodrigues, Cristina de Oliveira

; Kritski, Afrânio Lineu

; Sant’Anna, Clemax Couto

; Cardoso, Claudete Aparecida Araújo

; Sant’Anna, Maria de Fátima Bazhuni Pombo

Revista do Instituto de Medicina Tropical de São Paulo

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2020, Volume 62 elocation e81

Abstract: En | Text: En | PDF: En

ABSTRACT The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1 st , 2004, to December 1 st , 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB.

https://doi.org/10.1590/s1678-9946202062081 664 downloads

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